5-alpha-reductase deficiency

5α- reductase deficiency is a genetic disorder in which a protein called 5α reductase is defective or absent.

That’s an enzyme that converts the male hormone testosterone to its more potent form, called dihydrotestosterone.

One of the most important roles of dihydrotestosterone is to help male external genitalia develop in a male fetus.

Okay, normally, very early on in fetal life, male and female internal sex organs and external genitalia are undifferentiated and look identical.

Within the first few months of development, testes develop in the male fetus.

The testes start producing testosterone - a male steroid hormone that belongs to a class of hormones called androgens.

The testosterone gets released into the blood and a tiny fraction of it gets converted by 5α- reductase, which is mainly made in the skin of the genital area, into dihydrotestosterone.

Over time, dihydrotestosterone levels start rising and it affects undifferentiated genital structures.

Looking closely at these structures, at the top there’s the genital tubercle, which is a small projection.

Just below that, there's the urethral groove, which is the external opening of the urogenital sinus or the future urethra and bladder and is surrounded by the urethral folds and the labioscrotal swellings.

Now, once dihydrotestosterone reaches these structures, it makes the genital tubercle elongate into the phallus which will eventually be the penis.

The elongating genital tubercle pulls up the urethral folds which fuse in the midline, forming the spongy or penile urethra.

The tips of the urethral folds remain unfused and that forms the external urethral opening at the distal tip of the penis.

The labioscrotal swellings also fuse proximally to form the scrotum, which eventually houses the testes.